[Diabetes-talk] Accessible insulin pumps

[Veronica Elsea]

Wayne!
I am totally blind and have been using an insulin pump since 1991. 
The one I'm using right now is unfortunately no longer available. 
Many of the newer pumps don't have the keypad beeps like the older 
ones do, which is a bummer.
First, to a couple of your questions that haven't been addressed yet. 
Today there are no implantable pumps on the market. You insert a 
little catheter into your abdomen, arm or anywhere you'd give an 
injection. You attach tubing to it and the other end of the tubing is 
attached to the pump. You fill a cartridge with something like 200 or 
300 units of insulin, depending on your brand of pump. That cartridge 
goes into the pump and is attached to the famous tubing. The pumps do 
keep track of how much insulin remains in a cartridge and do warn you 
when it's getting low. Many people put the pump in a pocket. I happen 
to have a Velcro band that goes around my waist with a pocket for my 
pump. Some pump cases clip on to things like belts or something. Some 
pumps have remotes so you don't touch the pump itself much. But 
basically, you set the pump to deliver your background insulin 
automatically. This is kind of like what you're now doing with 
long-acting insulin. Then you push buttons, either on the remote or 
on the pump itself to take insulin to cover a meal or to lower a 
blood sugar. You may change to a temporary bolus if you plan to 
exercise a lot so you don't need so much insulin for awhile, or to 
increase the amount of insulin you need if you're stressed, ill, 
change medications or something. The nice thing about a pump over the 
long-acting insulin is that you can figure out things like, I need x 
units of insulin in the afternoon, but only t units in the evening. 
On my pump you can change the background or basal rate every half 
hour if you want. The other really important feature of pumps is 
something called insulin on board. So for instance, if you took 4 
units of insulin right now, then tested in two hours and got a high 
number. In your mind you might think okay, I need 1 unit to bring my 
blood sugar down. You'd then take insulin, but wait! The insulin you 
took two hours ago isn't completely used up in your system. The pump 
will keep track of how much you have left and will make sure you 
don't end up taking too much insulin. This is called stacking when 
you keep adding more insulin on top of insulin. A lot of people 
discover that they stop having so many lows once on a pump and this 
is usually why. My challenge with the Medtronic pumps is that at 
least as of a year ago, if you use the easy bolus, that insulin 
doesn't get entered into the insulin on board count.
When you first start using a pump, your team will help you figure out 
how to determine your rates, how long insulin stays in your system 
and all of that.  This is a lot of what happens during that learning 
curve, adjusting those rates. I'm not quite sure what I'm going to do 
in a year because I've really gotten used to having the ability to 
play with all of this stuff myself.
Right now, the main players are Medtronic, Animas, Accuchek and 
Omnipod. The Tandem T-slim will be out shortly, which is a 
touch-screen pump. Because accessibility is such an issue here for 
us, the best thing you can do is to set up a visit with the reps from 
each company. They'll happily come out, sit down with you and let you 
get your hands on each pump. They're all different sizes, have 
varying interfaces and we are all going to vary in what things are 
acceptable and what things are show-stoppers. Even how often you 
change the cartridge will vary from pump to pump. So I would say that 
if you approach this knowing you're in for one of those pioneering 
sort of times, knowing that you can contact any of us to scream, 
vent, ask for help or whine, don't be afraid to check out all the 
pumps. The last time around, I was able to wear each pump here for a 
couple of days because I was an experienced pump user. I'd be happy 
to go through some of the little quirks of the ones I've met as you 
look into them. As I said, I'm really not sure what I'll be doing 
once my time is up with my Cozmo. I'm trying to take some of my own 
advice and not let myself be scared of this. Now ask me how 
successful I am? <laughing!>
Anyway, hope this adds to the other posts and helps you for starters. 
You're more than welcome to contact me off list if you need more 
chatter. Happy researching!

Veronica

Watch and hear Veronica Elsea's Prayer for a Soldier at 
http://www.youtube.com/watch?v=KFoIhWrBHFI
Then learn about Music CDs that will impact and entertain you forever!
http://www.laurelcreekmusic.com
		Veronica Elsea, Owner
Laurel Creek Music Designs
Santa Cruz, California
831-429-6407